Medicare

[dianabee]

Thank you, Cece. The letter clearly states that the treatment is not covered for ms patients. Since the link between CcSVI and ms has not been made (at least officially via trials), my point is that IRs should be evaluating and treating patients irrespective of any MS diagnosis. Why would CcSVI need to be linked to ms in order to be treated??
If there are any IRs out there (dr scalifani?) can you please take a moment to consider this and comment? Why does ms need to be on the diagnosis for a reimbursement request?
Thx!

[drsclafani]

Thank you, Cece. The letter clearly states that the treatment is not covered for ms patients. Since the link between CcSVI and ms has not been made (at least officially via trials), my point is that IRs should be evaluating and treating patients irrespective of any MS diagnosis. Why would CcSVI need to be linked to ms in order to be treated??
If there are any IRs out there (dr scalifiani?) can you please take a moment to consider this and comment? Why does ms need to be on the diagnosis for a reimbursement request?
Thx!

i do not believe that i am treating MS. How in the world could inflating a balloon in the jugular veins reverse a demyelinating disease in 2-3 days? No i treat symptoms of venous outflow obstruction. i have done it in renal failure patients. and now i do it for other patient groups when a stenosis is identified

[dianabee]

Thanks Dr for the clarification. It sounds like ms should not in fact be associated with any insurance claims for CcSVI, and that the treatment for CcSVI Itself should be covered under Medicare.
So I am baffled by comments on this forum that Medicare is no longer covering the procedure. I don't understand why so many providers are linking the treatment to ms therapy, since that link is unproven and seems to cause insurance companies to deny coverage.
Thx again for responding.
Best regards
d.

[Cece]

dianabee, the providers are not linking the treatment to MS. The code is for vein compression, there is no mention of MS. Dr. Cumming said back on the first page that the way he thinks they can code discriminate is to look separately for an MS diagnosis in the patient's history. They are not denying the vein compression code on his other patients, only his MS patients.

Here's a link to the Empire BCBS policy that has BCBS denying coverage in NY:
http://www.empireblue.com/medicalpolici ... 136297.htm

I am upset about this, I agree with you and Dr. Sclafani that no one is treating MS directly, they are treating outflow obstructions, which is covered in other patient populations.

[munchkin]

This is what they have done in Canada, it is a treatable condition as long as you don't have MS.

As a Canadian I was hoping that we would catch onto the American system not the other way around.

I'm really sorry that this is happening there.

[nellie]

Seems we are all in agreement that IR's are treating vein stenosis. What can be done to fight back on insurances who seem to be using diagnosis as code discrimination?

[Cece]

I am waiting to hear of people appealing their denials and if they'll be successful in appeals. That will tell us how solid the insurance companies or Medicare are in their policy.... I would have appealed based on the severity of my stenoses.

[nellie]

Thanks Cece. A question. Are these effective dates for the date of the
procedure or when they make payment? I'm quessing the procedure.

[dianabee]

If the IR doctors are not identifying MS as a diagnosis on the claim, this is just flat out discriminatory and every denial should be vigorously appealed. I would urge every single patient to get commitment from your doctor befor your procedure, that should your claim be denied, they will help you fight it. This is what I intend to do. My procedure is in June.
I have had Drs in the past who would not help me fight a dEnial (not fascist Drs) so I know it us important to have the conversation up front. If they are hit with enough challenges with legitimate backup from physicians, they will stop this.
Definitely do not just roll over. It is important that we fight for our health.
Thx everyone who responded.
Dr Scalfini I meant no disrespect, I only wanted to hear your take on the issue. Thx again.
d.

[dianabee]

Not fascist in in previous post, should have said vascular ! Dang auto spell check...

[dianabee]

Cece et al, I just noticed on the bcbs document referenced above that is specifically say "for the treatment of ms", so I would hope that patients with this coverage are vigorously challenging their denied claims.
I have yet to see any Medicare document (except the one written to a specific patient) but I will search their site. I think they routinely update their policies.

[1eye]

Do not use the word multiple, do not use the word sclerosis, especially do not use them together, and avoid the initials 'MS' altogether, like the plague. What did it ever do for you?

Instruct all the people involved in your health care that you would like them to do the same and that you will not admit to any further association with these words or this term.

[Cece]

There is the organization "Angioplasty for All" in Canada that was looking into fighting this as discrimination. I wonder if there are any applicable lessons from how they are getting on.

[GinR]

I had a really good friend go to his appointment in Tampa, FL on Wednesday and was told that Medicare has denied the doctor's last 3 patients. My friend is heartbroken to say the least. To make it to surgery day and to find out that because you happen to have MS AND vascular issues that you are denied treatment.

[fogdweller]

Do not use the word multiple, do not use the word sclerosis, especially do not use them together, and avoid the initials 'MS' altogether, like the plague. What did it ever do for you?

Instruct all the people involved in your health care that you would like them to do the same and that you will not admit to any further association with these words or this term.

I wqsa very careful to have the IR's avoid any use of MS etc. in my diagnosis or my description of the surgery perofomred. Still denied. If any of your medical records say the pt has a history of MS, that seems to be the deah warrant for your claim.

Possible recourse: appeal, and cc all forms and comrrespondence to your state Insurance Commnissioner. If the Insurance Commisioner acts, he has the threat of disallowing the carrier to write insurance in your state. (The death penalt for insur co.s, but unlilely.)

File suite. We need to get a class action going. Class is all patiens with MS and confirmed diagnosis of venous compression that have been denied coverage. Pretty strainght forward.